MEDICARE: ALEKSANDR DADASHYAN, DDS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	26508	TX

General Provider Information

NPI Number	:	1457797284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALEKSANDR DADASHYAN, DDS, PC

Provider Business Mailing Address
First Line	:	9816 MEMORIAL BLVD STE 101
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77338-4205
Country	:	US
Telephone Number	:	281-446-6527
Fax Number	:	281-446-3619

Provider Business Practice Location Address
First Line	:	9816 MEMORIAL BLVD STE 101
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77338-4205
Country	:	US
Telephone Number	:	281-446-6527
Fax Number	:	281-446-3619

Authorized Official
Title or Position	:	OWNER
Name	:	ALEKSANDR DADASHYAN
Credential	:	DDS
Telephone Number	:	281-446-6527

Provider Enumeration Date	:	05/20/2013
Last Update Date	:	05/20/2013

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